Background Previous short-term work reported fewer suicides among elderly users of a telephone helpline and emergency response service (the TeleHelp-TeleCheck Service). Aims To examine long-term effects of the service on suicide in an elderly population of northern Italy. Method The service provided twice-weekly support and needs assessment telephone calls and a 24h emergency alarm service. Data from 1988 to 1998 allowed comparison of 18 641 service users with a comparable general population group of the Veneto region in Italy. Results Significantly fewer suicide deaths (nOBSERVED=6) occurred among elderly service users (standardised mortality ratio (SMR) 28.8%) than expected (nEXPECTED=20.86; 2=10.58, d.f.=1, P<0.001) despite an assumed overrepresentation of persons at increased risk. The service performed well for elderly females (nOBSERVED=2, SMR=16.6%, nEXPECTED=12.03; 2=8.36, d.f.=1, P<0.001). Conclusions The study confirms the initial promise of the TeleHelp-TeleCheck service over a much longer time period. Further research will clarify the apparent lack of benefit for elderly males.